Home Telehealth: Facilitators, Barriers, and Impact of Nurse Support Among High-Risk Dialysis Patients

Minatodani, Dayna; Chao, P.; Berman, Steven

doi:10.1089/tmj.2012.0201

Cited by 31 publications

(42 citation statements)

References 17 publications

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“…In the literatures, patients used SM solutions to manage their conditions by engaging in activities such as setting goals, monitoring their condition and adjusting medication. From the patient perspective, factors influencing adoption of these solutions included knowledge of their condition [ 10 , 11 , 31 , 35 , 36 , 38 , 45 , 50 , 58 , 62 , 72 , 82 ], their capability to comprehend and operate the solutions, their ability to embed or customise solutions into daily practices [ 33 , 39 , 41 , 44 , 46 , 56 , 57 , 69 ], visible effect of the solution [ 10 , 43 , 66 , 67 , 74 ], cost and quality of the solutions and their effectiveness to manage the condition such as sending accurate readings [ 33 , 35 , 45 , 52 , 61 , 70 , 71 , 79 ], family and healthcare professional support [ 9 , 39 , 40 , 50 – 53 , 58 , 75 ], the need for motivational factors [ 35 , 41 , 45 ] and their ability to make decisions on adjusting medication independently [ 61 , 79 ].…”

Section: Resultsmentioning

confidence: 99%

“…Similar sentiments were evident in ‘shared-decision making’ in that whilst some individuals preferred to take active part in the decision-making on their conditions [ 37 , 77 ], others were not confident or would rather leave decision-making to healthcare professionals, which decreased adoption [ 59 , 79 ]. Hence, empowerment was a facilitator for some [ 10 , 37 , 39 , 72 , 77 ], but not for others [ 59 , 72 , 79 ]. In diabetes self-management for example, Murphy and colleagues found that ‘being in control’ was the overall outcome that could be expected when a person was empowered to implement the Dose Adjustment For Normal Eating (DAFNE) principles to self-manage their diabetes; however, some participants found that DAFNE took more time, and found the uncertainty unsettling and the self-responsibility difficult, and quoted a participant saying: But I just have not got the determination nor the lifestyle, nor do I suppose really, do I want to be tied to it… [ 72 ].…”

Section: Resultsmentioning

confidence: 99%

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Factors influencing the adoption of self-management solutions: an interpretive synthesis of the literature on stakeholder experiences

et al. 2015

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BackgroundIn a research context, self-management solutions, which may range from simple book diaries to complex telehealth packages, designed to facilitate patients in managing their long-term conditions, have often shown cost-effectiveness, but their implementation in practice has frequently been challenging.MethodsWe conducted an interpretive qualitative synthesis of relevant articles identified through systematic searches of bibliographic databases in July 2014. We searched PubMed (Medline/NLM), Web of Science, LISTA (EBSCO), CINAHL, Embase and PsycINFO. Coding and analysis was inductive, using the framework method to code and to categorise themes. We took a sensemaking approach to the interpretation of findings.ResultsFifty-eight articles were selected for synthesis. Results showed that during adoption, factors identified as facilitators by some were experienced as barriers by others, and facilitators could change to barriers for the same adopter, depending on how adopters rationalise the solutions within their context when making decisions about (retaining) adoption. Sometimes, when adopters saw and experienced benefits of a solution, they continued using the solution but changed their minds when they could no longer see the benefits. Thus, adopters placed a positive value on the solution if they could constructively rationalise it (which increased adoption) and attached a negative rationale (decreasing adoption) if the solution did not meet their expectations. Key factors that influenced the way adopters rationalised the solutions consisted of costs and the added value of the solution to them and moral, social, motivational and cultural factors.ConclusionsConsidering ‘barriers’ and ‘facilitators’ for implementation may be too simplistic. Implementers could instead iteratively re-evaluate how potential facilitators and barriers are being experienced by adopters throughout the implementation process, to help adopters to retain constructive evaluations of the solution. Implementers need to pay attention to factors including (a) cost: how much resource will the intervention cost the patient or professional; (b) moral: to what extent will people adhere because they want to be ‘good’ patients and professionals; (c) social: the expectations of patients and professionals regarding the interactive support they will receive; (d) motivational: motivations to engage with the intervention and (e) cultural: how patients and professionals learn and integrate new skills into their daily routines, practices and cultures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Factors influencing the adoption of self-management solutions: an interpretive synthesis of the literature on stakeholder experiences

et al. 2015

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“…In a recent RCT, Tang et al [ 36 ] found that nurse-led, multi-disciplinary telehealth interventions were effective in improving A1C outcomes. In another nurse-led telehealth intervention designed for high-risk dialysis patients, the participants reported being more empowered and better able to provide needed self-management of illness [ 37 ]. In a recent RCT, Young et al found that a telehealth nurse coaching model for people with diabetes produced higher self-efficacy scores in the control group than for those who received the usual care [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach

Gee¹,

Greenwood²,

Paterniti³

et al. 2015

J Med Internet Res

236

260

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BackgroundChronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools.ObjectiveThe first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses.MethodsUsing Theory Derivation processes, we identified a “parent theory”, the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms “CCM or Chronic Care Model” AND “eHealth” or the specific identified components of eHealth. Additionally, “Chronic Illness Self-management support” AND “Technology” AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM.ResultsWe identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider.ConclusionsThe revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.

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“…[ 3 – 5 ] This is particularly important when patients are managing self-care processes such as home dialysis. [ 6 , 7 ] By RM and trend analysis of physiological parameters, the technology enables early detection of deterioration of non-compliance and a patient’s clinical condition. There is increasing evidence that RM data can help physicians and nurses to proactively manage a patient’s treatment.…”

Section: Introductionmentioning

confidence: 99%

Remote Monitoring of Chronic Diseases: A Landscape Assessment of Policies in Four European Countries

et al. 2016

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BackgroundRemote monitoring (RM) is defined as the surveillance of device-transmitted outpatient data. RM is expected to enable better management of chronic diseases. The objective of this research was to identify public policies concerning RM in four European countries.MethodsSearches of the medical literature, the Internet, and Ministry of Health websites for the United Kingdom (UK), Germany, Italy, and Spain were performed in order to identify RM policies for chronic diseases, including end stage renal disease (ESRD), chronic pulmonary obstructive disease (COPD), diabetes, heart failure, and hypertension. Searches were first performed in Q1 2014 and updated in Q4 2015. In addition, in depth interviews were conducted with payers/policymakers in each country. Information was obtained on existing policies, disease areas and RM services covered and level of reimbursement, other incentives such as quality indicators, past/current assessments of RM technologies, diseases perceived to benefit most from RM, and concerns about RM.ResultsPolicies on RM and/or telemedicine were identified in all four countries. Pilot projects (mostly in diabetes, COPD, and/or heart failure) existed or were planned in most countries. Perceived value of RM was moderate to high, with the highest rating given for heart failure. Interviewees expressed concerns about sharing of medical information, and the need for capital investment. Patients recently discharged from hospital, and patients living remotely, or with serious and/or complicated diseases, were believed to be the most likely to benefit from RM. Formal reimbursement is scarce, but more commonly available for patients with heart failure.ConclusionsIn the four European countries surveyed, RM has attracted considerable interest for its potential to increase the efficiency of healthcare for chronic diseases. Although rare at this moment, incentives to use RM technology are likely to increase in the near future as the body of evidence of clinical and/or economic benefit grows.

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Home Telehealth: Facilitators, Barriers, and Impact of Nurse Support Among High-Risk Dialysis Patients

Abstract: The results suggest that home telehealth self-monitoring with RCN support is effective in empowering patients to take a more active role in their healthcare and indirectly improve quality of life for those living with chronic illness.

Cited by 31 publications

References 17 publications

Factors influencing the adoption of self-management solutions: an interpretive synthesis of the literature on stakeholder experiences

Factors influencing the adoption of self-management solutions: an interpretive synthesis of the literature on stakeholder experiences

The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach

Remote Monitoring of Chronic Diseases: A Landscape Assessment of Policies in Four European Countries

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